GLP-1 RAs could inhibit the expression of plasminogen activator inhibitor type-1 (PAI-1) and vascular adhesion molecule (VAM) in human vascular endothelial cells in vitro, which had a protective effect against endothelial cell dysfunction (ECD) in the early stages of diabetic vascular disease [32] and might explain the lower incidence of background and severe nonproliferative DR among individuals who used GLP-1 RAs. The gene discussed is GLP1R; the disease is familial atrioventricular septal defect.